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Nursing is valued for specialized knowledge, skill, and caring in improving the health of the public and ensuring safe, quality care.1,2 These concepts define professional nursing practice and serve as a guiding compass for all clinicians. Professional nursing is based on a social contract from which the nurse is granted privileges and, in turn, is accountable to the public. Changes in the population and the community directly impact the profession. Advances in technology, public demand for improved clinical outcomes, and the need for new models of care have accelerated the need for nurses with the skills and knowledge to manage a challenging healthcare environment.

If nurses are to possess the capabilities to manage in complex systems, they must be educated in systems theory and the frameworks for translation of new knowledge to practice. Competencies in leadership, healthcare policy, population health, and evidence-based practice will be expectations for all nurses. Experts have demonstrated a correlation between higher levels of nurse education and improved patient outcomes3-8 and recommended the redesign of nursing curriculum and education standards.9-12 In 2010, the Institute of Medicine’s (IOM) Future of Nursing report set a bold goal and challenged the profession to achieve an 80% baccalaureate degree (BSN) in the nursing workforce by 2020.12 The authors of the IOM report established this target after an assessment of progress on education progression among academic institutions and availability in registered nurse (RN) to BSN programs across the country.12 After a comprehensive review of the literature and consultation with experts, the Commission on Magnet Recognition® (the Commission) established a standard that effective June 2013, all applicant and redesignating organizations are required to develop an action plan and set a target, demonstrating progress toward having 80% of RNs obtain a BSN or graduate degree in nursing by 2020.13 Magnet® organizations have a history of leading change and facilitating innovation.14 The Commission holds the opinion that to be full partners in leading healthcare reform and designers of new systems impacting population health, nurses need the foundation of BSN preparation.

New education models and partnerships are flourishing throughout the country. In North Carolina, transformational nursing leaders from community colleges, universities, and healthcare organizations have blended the associate degree (AD) and BSN into an innovative regionally based program.15 Dually enrolled in a community college and university, students attend 3 years at the community college, completing general education classes and obtaining their AD. Students then sit for the NCLEX and work part-time as RNs at participating healthcare organizations. Graduates acquire their BSN degree after a 4th and final year at a university. It is expected that by 2020, 55 community colleges and 15 universities across North Carolina will offer this innovative option. Collaboration beyond traditional articulation agreements became a reality because dedicated nurse leaders removed old institutional barriers.15

In Florida, 9 community colleges award BSNs, and at least 3 other states are working on similar strategies.16 In Virginia, 16 Magnet organizations piloted a predictive modeling tool developed by J. Cain and D. Zimmermann (unpublished data, 2012) that allows frontline managers and organizational leaders to accurately forecast the impact of policy changes on education progression of the workforce (see Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A229). More than 2000 nurses have learned to use the model, and Virginia chief nursing officers (CNOs) agreed to institute workforce policies on education progression.17 Policies vary depending on individual organizational needs and demographics, but in a recent survey of CNOs, a growing number of employers have established timelines requiring new nurses to complete a BSN within 3 to 5 years of hire.18 Employers are offering onsite collegiate education, advancement opportunities through clinical ladders, and flexible scheduling for students. In every state, nurses are collaborating and implementing strategies tailored to their unique environments.16 The work of state coalitions from the Future of Nursing Campaign for Action (http://thefutureofnursing.org/) highlights strategies that are under way across the country.

As the nation’s largest group of licensed healthcare professionals, nurses play a pivotal role in the design, delivery, and transformation of healthcare. An investment in education serves the nation’s health and advances the greater good. Supporting BSN education is an essential next step in the progression toward a more educated nursing workforce. Nursing is positioned to assume a leadership role in healthcare reform, and it is up to nursing to raise the standards so that the vision becomes a reality.

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